When lifestyle approaches fail, what can drugs and surgery offer in the management of obese patients? Geoff Watts gets expert advice on current and future options

Three fifths of adults in England are either overweight or obese1; so are almost a quarter of 4 to 5 year olds. If present trends continue, three fifths of all men, half of all women, and a quarter of all children will be obese by 2050. Global numbers have more than doubled since 1980.

Unless lifestyle changes prove a lot more effective than they have so far in halting the rise of obesity, we’re looking at drugs and surgery. But which? And which drugs and which surgery? These and other taxing questions were aired at a recent meeting in London, arranged by the Royal Society of Medicine, on the future of obesity treatment. It became clear that attempts to tackle obesity after the event still face daunting hurdles—scientific, practical, or both.

The non-drug medical management of obesity is where it all starts: a package of familiar measures including diet, exercise, behaviour modification, and various forms of psychological support. Studies have shown that single figure percentage weight losses can be achieved and maintained with these measures, but not without commitment on the part of the patient.

Drug treatments can’t completely sidestep that need for commitment, but they can lessen it—at least in theory. Obesity is one area in which pills have so far played little part. “There have been a lot of disappointments,” says Professor Sir Stephen Bloom, head of diabetes and endocrinology, Imperial College. He points out that although the past 25 years have seen 123 products going through clinical trials, only one is currently available on the UK market. This lone survivor is orlistat, which blocks a fat digesting enzyme. Although …